July 23, 2024 - Met with the head and neck surgeon

 I met with Dr. Uys (Ace) , a ENT, Head, and Neck surgeon who has an office in the city. Dr. Uys explained that in terms of the biopsy, the only risk factor for thyroid cancer is a first degree family history: mom, dad, siblings. He said that my needle biopsy looks like there's atypical cells; it doesn't necessarily say that there's thyroid cancer, but it does say there are some concerning features, and if they look at the cells under the microscope that says it might be thyroid cancer, so what the lab then does with those cells is they do molecular testing, and they go and look at the DNA of the cells to see if you have a mutation. 

Dr. Uys told me "If you have a mutation, it increases the risk of it actually being a cancer. You don't have a mutation. The challenging thing is it still puts you at like a 27% risk of that nodule being cancer. That means if we cut it out, seven out of 10 cases will be benign, will not be cancer. Okay. One, three out of 10 will be cancer. You have three options to manage this. Normally one nothing. We just repeat the ultrasound and that's reasonable. If things change on the ultrasound, then you need to have surgery. Two is take out the thyroid lobe. So the thyroid has a left lobe and a right lobe. So we can take up the right hook 'cause that's where the big one is. And leave the left one. The problem is you have a nodule on the left side as well.It's a smaller one. That doesn't look like a problem, but you should know that there is one there. The third option is to take out the whole thyroid and you know, you don't have any issues with regards to thyroid cancer being a problem. But then you have to be on Synthroid for the rest of your life. So you need to be on a tablet then. Mm-Hmm. because you are taking out thyroid gland, then we need to supplement you with thyroid hormone. The only thing that you have to realize is the size of your nodule is more than four centimeters. If it's more than four centimeters, it's a little bit of a shot in the dark trying to say, well that neo biopsy was accurate. You've got this big mass and they're putting a needle in. How do you know they got the right one And the doctor that looked at the cell said this looks like it might be thyroid cancer. I think you wanna avoid surgery, which is good, but you have to realize you might be avoiding surgery to make things harder. Yeah. In the future all, if we're gonna do something, I would suggest it might be worthwhile to take out the half. So if we take out half of your thyroid, the advantages is you're most likely not gonna need to be on Synthroid. You don't need extra medication. Okay. We're not bothering the left side. You are leaving all the dangerous, dangerous structures on the left alone. The only thing if we do the right side and it comes back as cancer, then you need a second operation, then we need to take up the left one. But that only happens in three out of 10. So the odds are stacked in your favor to just take out half the load. My recommendation would be to consider doing that rather than just watching it."

Dr. Uys then felt my neck and then asked me to lift my chin up so he could put a camera in my nose to look at my voice box. The camera tickled my nose and was also painful, but I managed to get through it.

Finally, Dr. Uys told me, "Normally I would recommend that you have just your thyroid lobar. The challenging thing with you is that when they looked at the cells, they said, this looks atypical. We really think this might be thyroid cancer. Okay. So to me the chances of you having half out and then needing a second operation is pretty high. It's pretty 50%, so then you've gotta say, okay, I'm okay to be on some for the rest of my life. Just get it out. Then we get it out and you don't have to worry about it. 99% of people with thyroid cancer are alive 20 years later. You will not die from this."

The surgery date, he said, would probably be in September cause they had to wait for surgery time.